Developmental Trajectories of Religious Service Attendance: Predictors of Nicotine Dependence and Alcohol Dependence/Abuse in Early Midlife.

This longitudinal study assesses the associations between developmental trajectories of religious service attendance from mean age 14 to mean age 43 and nicotine dependence and alcohol dependence/abuse at mean age 43 (N = 548). Six trajectories of religious service attendance were identified. As compared with belonging to weekly stable trajectory group, a higher probability of belonging to the weekly/none decreasing, occasional stable, and non-attendance trajectory group was significantly associated with a higher likelihood of nicotine dependence. In addition, as compared with belonging to weekly stable trajectory group, a higher probability of belonging to the weekly/none decreasing, weekly/occasional decreasing, occasional stable, and non-attendance trajectory group was significantly associated with a higher likelihood of alcohol dependence/abuse. These findings are consistent with the hypothesis that religious service attendance protects against nicotine dependence and alcohol dependence/abuse in early midlife.

Critical Factors Influencing Interorganizational Relationships Between Juvenile Probation and Behavioral Health Agencies.

Although interorganizational relationships (IORs) are essential to the effective delivery of human services, very little research has examined relationships between juvenile justice agencies and behavioral health providers, and few studies have identified the most critical organizational and individual-level characteristics influencing IORs. Across 36 sites, juvenile probation officials (n = 458) and community behavioral health providers (n = 91) were surveyed about characteristics of their agencies, themselves, and IORs with each other. Generalized Linear Mixed Models were used to analyze the data. The strongest predictors included Perceived Organizational Support and individual Adaptability. Implications for research, theory and practice are discussed.

From the Front Lines of the Appalachian Addiction Crisis: Healthcare Providers Discuss Opioids, Meth and Recovery.

The Journal of Appalachian Health is dedicated to reviewing various types of media related to contemporary concepts that affect the health of Appalachia. As the opioid-related overdose deaths ravish Appalachia, now more than ever, we each must devote energy to understanding addiction and pathways to recovery. Dr. Carl Leukefeld reviews the book From the Front Lines of the Appalachian Addiction Crisis: Healthcare Providers Discuss Opioids, Meth and Recovery.

Geographic differences in substance use screening for justice-involved youth.

Justice-involved youth report high rates of substance use. Community Supervision (CS) agencies are uniquely positioned to impact public health through substance use identification and early intervention. Geographic location (i.e., living in an urban versus rural area) is an understudied factor that can be associated with differences in service and resource availability. A secondary analysis of a nationally representative sample of CS agencies assessed agency and youth characteristics, as well as substance use screening in urban and rural CS agencies. Respondents representing rural agencies reported higher rates of substance use, yet were less likely to report using screeners focused on substance use. Respondents representing urban CS agencies reported a wider variety of screening instruments and were more likely to test for drug use during screening. Differences in the screening process can reflect adaptive and culturally responsive approaches to addressing substance use as well as unique barriers to service provision. System-wide improvement is contingent upon implementation strategies that identify and acknowledge geographic differences to more adequately address the common and unique needs of the justice-involved youth they serve.

Patterns of buprenorphine use and risk for re-arrest among highly vulnerable opioid-involved women released from jails in rural Appalachia.

Aims: Opioid use is common among correctional populations, yet few inmates receive treatment during incarceration or post-release, particularly in rural areas. This article examines associations of buprenorphine use, licit and illicit, health services use, and risk for re-arrest within 3 months of jail release among rural opioid-involved women. Methods: Women were randomly selected from three rural Appalachian jails. Those with moderate to severe opioid-involvement on the NM-ASSIST, and data on patterns of buprenorphine use (N = 188), were included in this analysis. Logistic regression analyses examined predictors of re-arrest within 3 months of release. Results: Median age was 32, all were White. At follow-up, 39 (22.7%) had been rearrested; 9 (5.2%) reported receiving MAT, all with buprenorphine. Significant risk factors for re-arrest included: number of days high, injection use, number of illicit buprenorphine days, and withdrawal symptoms in the follow-up period. The sole protective factor was having a regular source of healthcare at follow-up. Conclusions: Rural opioid-involved women released from jail are highly vulnerable to re-arrest, and lack access to supportive care systems for substance treatment. Innovations to integrate MAT into reentry to improve access is recommended.

Season of birth: A predictor of ADHD symptoms in early midlife.

OBJECTIVE: In this longitudinal study, we applied linear regression analyses to examine season of birth as related to symptoms of attention deficit/hyperactivity disorder (ADHD) in early midlife. METHOD: We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. FINDINGS: The findings indicate that, as compared with participants who were born in the summer, those who were born in the spring (Beta = 0.34; t-statistic = 3.59; p < 0.001) had significantly more ADHD symptoms. In addition, exposure to maternal cigarette smoking in adolescence significantly intensified (p < 0.01) the association between season of birth and ADHD symptoms in early midlife. CONCLUSION: These findings suggest that exposure to greater maternal maladaptive behaviors, such as cigarette smoking, may result in a greater vulnerability to other environmental risk factors, such as season of birth.

Hepatitis C antibody reactivity among high-risk rural women: opportunities for services and treatment in the criminal justice system.

Purpose The purpose of this paper is to examine the drug use and criminal justice factors related to hepatitis C virus (HCV) antibody reactivity among rural women in the USA recruited from local jails. Design/methodology/approach Analyses included 277 women with a history of injection drug use from three rural jails in Kentucky. Participants completed health and drug use questionnaires and received antibody testing for HCV. Findings The majority of women tested reactive to the HCV antibody (69 percent). Reactivity was associated with risk factors, such as unsterile needle use. Criminal justice variables, including an increased likelihood of prison incarceration, an earlier age of first arrest, and a longer incarceration history, were associated with HCV reactive tests. Participants also endorsed several barriers to seeking healthcare before entering jail that were more prevalent in women testing HCV reactive regardless of HCV status awareness before entering jail. Originality/value Injection and high-risk sharing practices as well as criminal justice factors were significantly associated with HCV reactivity. Future research and practice could focus on opportunities for linkages to HCV treatment during incarceration as well as during community re-entry to help overcome real or perceived treatment barriers. The current study highlights the importance of the criminal justice system as a non-traditional, real-world setting to examine drug use and related health consequences such as HCV by describing the association of high-risk drug use and criminal justice consequences with HCV among rural women recruited from local jails.

African American women and sexually transmitted infections: The contextual influence of unbalanced sex ratios and individual risk behaviors.

This study uses data from 564 African American women to examine the correlates of lifetime prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions about the availability of African American males, five partner characteristics, and drug history. At the bivariate-level, women with an STI diagnosis were significantly more likely to have dated a man who was married, older, had sex with another man, involved in concurrent partnerships, and had been incarcerated. About half of the participants stated it was difficult to find an eligible African American male and attributed the limited pool of same-race partners to drug trafficking, a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug use during sex were positively associated with ever having an STI. Individual and contextual implications are addressed.

The Benefits of Community and Juvenile Justice Involvement in Organizational Research.

The Juvenile Justice (JJ) system has a number of local behavioral health service community linkages for substance abuse, mental health, and HIV services. However, there have only been a few systemic studies that examine and seek to improve these community behavioral health linkages for justice-involved youth. Implementation research is a way of identifying, testing, and understanding effective strategies for translating evidence-based treatment and prevention approaches into service delivery. This article explores benefits and challenges of participatory research within the context of the National Institute on Drug Abuse (NIDA)'s Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) implementation behavioral health study. The JJ-TRIALS study has involved JJ partners (representatives from state-level JJ agencies) throughout the study development, design, and implementation. Proponents of participatory research argue that such participation strengthens relations between the community and academia; ensures the relevancy of research questions; increases the capacity of data collection; and enhances program recruitment, sustainability, and extension. The extent of the impact that JJ partners have had on the JJ-TRIALS study will be discussed, as well as the benefits local JJ agencies can derive from both short- and long-term participation. Issues associated with the site selection, participation, and implementation of evidence-based practices also will be discussed.

Psychosocial Factors Related to the Intergenerational Transmission of Externalizing Behaviors in Early Midlife.

BACKGROUND: To study the intergenerational transmission of externalizing behaviors. METHODS: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife. RESULTS: First, maternal externalizing behaviors were indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's smoking patterns, and the offspring's marital conflict. Second, maternal cigarette smoking was indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's cigarette smoking, and the offspring's marital conflict. Third, maternal marital conflict had an indirect effect on the offspring's externalizing behaviors, mediated by offspring marital conflict. CONCLUSIONS: The finding that externalizing behaviors can be transmitted from parent to child informs the need for family-based interventions that are appropriate to adolescents.

Lack of Preventive Health Behaviors in the Early Forties: The Role of Earlier Trajectories of Cigarette Smoking From Adolescence to Adulthood.

OBJECTIVE: To study the degree to which individuals in different trajectories of cigarette smoking from adolescence to the early forties are similar or different in terms of lack of preventive health behaviors (e.g., underuse of preventive health services, unhealthy eating habits) in early midlife. METHODS: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from adolescence to early midlife (mean age = 43 years, standard deviation [SD] = 2.8) at seven time points. Using growth mixture modeling, we statistically identified the number of smoking trajectories. Logistic regression analysis was used to study the relationship between the probabilities of participants' smoking trajectory group membership and lack of preventive behaviors in early midlife. RESULTS: Five trajectory groups of cigarette smokers were identified. With controls, as compared with the nonsmoker trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory groups were significantly associated with a higher likelihood of lack of preventive health behaviors (adjusted odds ratio [AOR] = 3.49 and 4.02 respectively). In addition, as compared to the quitter/decreaser trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory group were also significantly associated with a higher likelihood of lack of preventive health behaviors (AOR = 3.51 and 4.04 respectively). CONCLUSIONS: Intervention programs may consider focusing on heavy/continuous smokers and late starters in programs designed to promote adequate use of preventive health services and healthy general lifestyles in early midlife.

Compulsive buying and quality of life: An estimate of the monetary cost of compulsive buying among adults in early midlife.

The aims of this study were to examine the associations between compulsive buying and quality of life and to estimate the monetary cost of compulsive buying for a cohort of men and women at mean age 43. Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. Linear regression analyses showed that compulsive buying was significantly associated with quality of life, despite controlling for relevant demographic and psychosocial factors. The estimated monetary cost of compulsive buying for this cohort was significant. The fact that the monetary cost of CB is not trivial suggests that individuals are both consciously and unconsciously plagued by their CB. The findings are important for interventionists and clinicians for cost-effective intervention and treatment programs.

A Preliminary Study Examining Women's Physical Health and Nonmedical Prescription Opioid Use in a Recovering Framework.

BACKGROUND: There is a growing need for research on women recovering from nonmedical prescription opioid use. A paradigm shift is to focus on wellness and factors that support, rather than hinder, recovering women. For example, although physical health is impacted by nonmedical prescription opioid use, improved health may be a strength-based factor among recovering women. The aim of this preliminary study was to examine physical health in a recovering framework as women begin recovering from nonmedical prescription opiate use. MATERIALS AND METHODS: This study conducted secondary data analysis using self-report data from Kentucky's Targeted Assessment Program (TAP). TAP assesses and provides pretreatment for problems impeding work or interfering with parental responsibilities. Data included 1247 adult women reporting a history of nonmedical prescription opioid use and receiving pretreatment. Bivariate and logistic regression analyses examined whether physical health and access to health services at baseline were associated with substance-related behavior change upon completion of pretreatment. RESULTS: Women reporting better physical health and fewer days with no activities due to health barriers were more likely to engage in pretreatment substance-related behavior change [χ2(8) = 34.6, p < 0.05]. However, ∼40% of women reported barriers in accessing healthcare. CONCLUSION: Using a recovering framework, women's physical health, as expected, is associated with engagement in pretreatment substance-related behavior change. Ongoing service coordination with practitioners and medical providers should be incorporated into care to meet the need. Future research should continue to examine factors that support recovering women, using a recovering framework.

Psychosocial Factors Related to Underuse of Medical Services.

In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent-child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.

Longitudinal psychosocial factors related to symptoms of Internet addiction among adults in early midlife.

In this longitudinal study, we applied structural equation modeling (SEM) to examine the psychosocial factors from adolescence to adulthood as related to symptoms of Internet addiction (IA) during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N=548) followed from adolescence to early midlife (mean age=43; SD=2.8). The findings supported a meditational model: adolescent (mean age=16) conflictual parent-child relationship was associated with internalizing problem behaviors at mean age 21 in emerging adulthood (b=0.13, p<0.01), which, in turn, were associated with both alcohol/drug use problems at mean age 27-32 (b=0.24, p<0.001) and affective disorders at mean age 37 (b=0.29, p<0.001), which, ultimately, were associated with symptoms of IA in early midlife (b=0.23, p<0.01; b=0.21, p<0.05, respectively). In addition, alcohol/drug use problems were associated with affective disorders (b=0.22, p<0.05). Among the constructs, alcohol/drug use problems had the greatest total effects on symptoms of IA in early midlife (b=0.28, p<0.001). Findings suggest that family therapy focused on an increase in the affectionate relationship between the adolescent and his/her parents, cognitive-behavioral treatment of internalizing problem behaviors, and effective treatment of individuals who have alcohol/drug use problems may reduce the likelihood of having symptoms of IA in early midlife.

Marijuana use from adolescence to adulthood: developmental trajectories and their outcomes.

BACKGROUND: The study assesses the degree to which individuals in different trajectories of marijuana use are similar or different in terms of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, children living at home, and spouse/partner marijuana use at age 43. METHOD: This study used a longitudinal design. The sample participants (N = 548) were first studied at mean age 14 and last studied at mean age 43. RESULTS: Six trajectories of marijuana use were identified: chronic/heavy users (3.6 %), increasing users (5.1 %), chronic/occasional users (20 %), decreasers (14.3 %), quitters (22.5 %), and nonusers/experimenters (34.5 %). With three exceptions, as compared with being a nonuser/experimenter, a higher probability of belonging to the chronic/heavy, the increasing, or the chronic/occasional user trajectory group was significantly associated with a greater likelihood of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, not having children who lived at home, and having a spouse/partner who used marijuana at early midlife. In addition, compared with being a quitter, a higher probability of belonging to the chronic/heavy user trajectory group was significantly associated with a higher likelihood of unconventional behavior, sensation seeking, emotional dysregulation, alcohol dependence/abuse, and spouse/partner marijuana use. Implications for intervention are presented. CONCLUSIONS: Trajectories of marijuana use, especially chronic/heavy use, increasing use, and chronic/occasional use, are associated with unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, having children who lived at home, and spouse/partner marijuana use at age 43. The importance of the findings for prevention and treatment programs are discussed.

Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women.

The objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.

Trajectories of marijuana use from adolescence to adulthood as predictors of unemployment status in the early forties.

OBJECTIVES: To study the degree to which individuals in different trajectories of marijuana use are similar or different in terms of unemployment status at mean age 43. METHODS: We gathered longitudinal data on a prospective cohort taken from a community sample (N = 548). Forty-nine percent of the original participants were females. Over 90% of the participants were white. The participants were followed from adolescence to early midlife. The mean ages of participants at the follow-up interviews were 14.1, 16.3, 22.3, 27.0, 31.9, 36.6, and 43.0, respectively. We used the growth mixture modeling (GMM) approach to identify the trajectories of marijuana use over a 29-year period. RESULTS: Five trajectories of marijuana use were identified: chronic users/decreasers (8.3%), quitters (18.6%), increasing users (7.3%), chronic occasional users (25.6%), and nonusers/experimenters (40.2%). Compared with nonusers/experimenters, chronic users/decreasers had a significantly higher likelihood of unemployment at mean age 43 (adjusted odds ratio = 3.51, 95% confidence interval = 1.13-10.91), even after controlling for the covariates. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The results of the associations between the distinct trajectories of marijuana use and unemployment in early midlife indicate that it is important to develop intervention programs targeting chronic marijuana use as well as unemployment in individuals at this stage of development. Results from this study should encourage clinicians, teachers, and parents to assess and treat chronic marijuana use in adolescents.

"I'm Stuck": Women's Navigations of Social Networks and Prescription Drug Misuse in Central Appalachia.

This study utilizes anthropological analyses of kinship, care, gendered inequalities, and the state to examine how social networks affect women's substance use in a rural Appalachian county where the primary drug of choice is prescription opioids. Of 503 participants from a larger study of social networks among rural drug users, 16 women who reported using drugs with four or more other study participants (drug network members) were interviewed from November 2011 to February 2012. The purpose of interviews is to analyze the substance use patterns among participants who are highly connected in their networks. Female participants say they feel "stuck" in cycles of prescription drug misuse because of entrenchment in moral economies, intensive caretaking responsibilities, and violence from those in their networks. Although women demonstrate agency in their navigations of drug use, relationships, and economic and health inequalities, the factors that constrain women's actions culminate to create barriers for women accessing substance abuse treatment or decreasing substance use outside of treatment. This study adds to understandings of the relational and situational aspects of women's drug use and efforts to decrease use. Recognizing these aspects of women's lives will aid policies and programs in becoming more relevant to substance abusing women. (substance use; kinship; care; gendered inequalities; Appalachia).

Compulsive buying: Earlier illicit drug use, impulse buying, depression, and adult ADHD symptoms.

This longitudinal study examined the association between psychosocial antecedents, including illicit drug use, and adult compulsive buying (CB) across a 29-year time period from mean age 14 to mean age 43. Participants originally came from a community-based random sample of residents in two upstate New York counties. Multivariate linear regression analysis was used to study the relationship between the participant's earlier psychosocial antecedents and adult CB in the fifth decade of life. The results of the multivariate linear regression analyses showed that gender (female), earlier adult impulse buying (IB), depressive mood, illicit drug use, and concurrent ADHD symptoms were all significantly associated with adult CB at mean age 43. It is important that clinicians treating CB in adults should consider the role of drug use, symptoms of ADHD, IB, depression, and family factors in CB.